葱白（四两） 干姜（一两） 附子（一枚生用去皮破八片）上三味以水三升煮取一升去滓分温再服（内经曰肾苦
燥急食辛以润之葱白之辛以通阳气姜附之辛以散阴寒）
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 附子（一枚生去皮破八片） 人尿（五合） 猪胆汁（一合）以上三味以水三升煮
取一升去滓纳胆汁人尿和令相得分温再服如无猪胆亦可用（内经曰若调寒热之逆冷热必行则热物冷服下嗌之后冷体既消
热性便发由是病气随愈呕哕皆除情且不违而致大益此和人尿猪胆汁咸苦寒物于白通汤热剂中要其气相从则可以去格拒
之寒也）
张 或谓白通汤及白通加猪胆汤真武汤与通脉四逆汤皆为少阴下利而设除用姜附相同其余之药俱各殊异何也盖病
殊则药异夫少阴下利寒气已甚非姜附则不能治然下利之理无殊而兼有之证不一用药故不同耳亦各从其宜也如白通汤用
姜附以散寒止利加葱白以通调阳气若利而干呕烦者寒气太甚内为格拒姜附非烦者之所宜姜附必呕而不纳加人尿猪胆汁
于白通汤中候温冷而服之人尿猪胆汁皆咸苦性寒之物是以纳而不阻至其所则冷体既消热性便发真武汤治少阴病二三日
不已至四五日腹满小便不利四肢沉重疼痛自下利者为有水气故多或为之证夫水气者寒湿也肾主之肾病不能制水水饮停
蓄为水气腹痛寒湿内甚也四肢沉重疼痛寒湿外甚也小便不利自下利者湿甚而水谷不能别也经曰脾恶湿甘先入脾茯苓白
术之甘可以益脾逐水寒湿所胜平以辛热湿淫所胜佐以酸辛附子芍药生姜之酸辛以温经散湿太阳篇中小青龙汤证亦为有
水气故多或为之证如真武汤者不殊此理也通脉四逆治少阴下利清谷里寒外热手足厥逆脉微欲绝者为里寒身热恶寒而面
色赤为外热此阴甚于内格阳于外不相通与通脉四逆汤以散阴通阳其或为之证根据法加减而治之以上四证俱云下利而兼有
或为之证不一是以用药大同而小异也又曰或云白通汤用附子凡四证惟真武汤一证熟用余皆生用何也凡附子生用则温经
散寒非干姜佐之则不可炮熟则益阳除湿用生姜相辅以为宜矣干姜辛热故佐生附为用生姜辛温少资熟附之功原佐使之元
无出此理然白通等汤以下利为重其真武汤证以寒湿为先故用药有轻重之殊耳盖寒淫风湿大体颇同如太阳下编桂枝附子
汤治寒湿相搏附子亦用炮熟仍用生姜以佐之其生熟之用轻重之分无过此理也
少阴病咳而下利谵语者被火气劫故也小便必难以强责少阴汗也（成 咳而下利者里寒而亡津液也反以火劫强责少阴
汗者津液内竭加火气烦之故谵语小便难也）少阴病下利便脓血者可刺少阴病下利脉微涩呕而汗出必数更衣反少者当其上
灸之少阴病脉紧至七八日自下利脉暴微手足反温脉紧反去者为欲解也虽烦下利必自愈少阴病脉微沉细欲卧汗出而烦欲
吐自下利复烦躁不得寐者死少阴病下利止而头眩时时自冒者死（庞 此合是少阳冒昧汗 然出脉匀小浮者生少阴无眩冒
之证）少阴病恶寒身蜷而利手足逆冷者不治
厥阴 伤寒始发热六日厥反九日而利凡厥利者当不能食今反能食者恐为除中食以索饼不发热者知胃气尚在必愈恐
暴热来出而复去也后三日脉之其热续在者期之旦日夜半愈所以然者本发热六日厥反九日复发热三日并前六日亦为九日
与厥相应故期之旦日夜半愈后三日脉之而脉数其热不罢者此为热气有余必发痈脓也（详厥）伤寒先厥后发热下利必自止
而反汗出咽中痛者其喉为痹发热无汗而利必自止若不止必便脓血便脓血者其喉不痹 下利寸脉反浮数尺中自涩者必清
脓血（黄连阿胶汤黄芩汤成 下利者脉当沉而迟反浮数者里有热也涩为无血尺中涩者肠胃血散也热随利下必便浓血清与
圊通脉经曰清者厕也）热利下重者白头翁汤主之（利则津液少热则伤气气虚下利致后重也与白头翁汤散气浓肠）下利欲
饮水者以有热故也白头翁汤主之（渴自利不为脏寒与四逆以温脏下利饮水为有热与白头翁汤以凉中按少阴自利而渴乃下
焦虚寒而用四逆者恐不可以渴不渴分热寒也正当以小便黄白别之耳）
白头翁汤方
白头翁（二两） 黄柏 秦皮 黄连（各三两）上四味以水七升煮取二升去滓温服一升不愈更服一升（内经曰肾欲
坚急食苦以坚之利则下焦虚是以纯苦之剂坚之）
下利脉数有微热汗出今自愈设复紧为未解（干姜黄连人参汤）下利脉数而渴者今自愈设不瘥必清脓血以有热故也（黄
连汤）下利脉沉弦者下重也脉大者为未止脉微弱数者为欲自止虽发热不死（成 沉为在里弦为拘急里气不足是主下重大
则病进为利未止脉微数弱者邪气微而阳气复为欲自止虽发热止由阳胜非大逆也脉沉弦四逆之类脉大葛根黄芩黄连汤）伤
寒六七日大下后寸脉沉而迟手足厥逆下部脉不至咽喉不利唾脓血泄利不止者为难治麻黄升麻汤主之（成 伤寒六七日邪
传厥阴之时大下之后下焦气虚阳气内陷寸脉迟而手足厥逆下部脉不至厥阴之脉贯膈上注肺循喉咙在厥阴随经射肺因亡
津液遂成肺痿咽喉不利而唾脓血也金匮要略曰肺痿之病从何得之被快药下利重亡津液故得之若泄利不止者为里气大虚
故云难治与麻黄升麻汤以调肝肺之气）
麻黄升麻汤方
麻黄（去节二两半） 升麻 当归（各一两二钱半） 知母 黄芩 葳蕤（各十八铢） 石膏（碎绵裹） 白术 干
姜芍药 天门冬（去心）桂枝 茯苓 甘草（炙各六铢）
上十四味以水一斗先煮麻黄一两沸去上沫纳诸药煮取三升去滓分温三服相去如炊三斗米顷令尽汗出愈（成 玉函曰
大热之气寒以取之甚热之气以汗发之麻黄升麻之甘以发浮热正气虚者以辛润之当归桂姜之辛以散寒上热者以苦泄之知
母黄芩之苦凉心去热津液少者以甘润之茯苓白术之甘缓脾生津肺燥气热以酸收之以甘缓之芍药之酸以敛逆气葳蕤门冬
石膏甘草之甘润肺除热）
厥阴病消渴气上撞心心中疼热饥而不欲食食则吐蛔下之利不止（详厥阴病）伤寒四五日腹中痛若转气下趣少腹者此
欲自利也（详腹痛）脉浮而迟表热里热下利清谷四逆汤大汗出热不去内拘急四肢疼又下利厥逆而恶寒者四逆汤下利清谷
里寒外热汗出而厥者通脉四逆汤大汗若大下利而厥冷者四逆汤下利清谷不可攻表汗出必胀满四逆汤伤寒先厥后发热而
利者必自止见厥复利四逆汤下利脉沉而迟其人面少赤身有微热下利清谷者必郁冒汗出而解病患必微厥下虚故也四逆汤
下利后脉绝手足厥冷 时（周时也）脉还手足温者生脉不还者死（或用白通汤通脉四逆汤）下利后更烦按之心下濡者虚
烦也栀子豉汤下利谵语有燥屎也宜小承气汤下利手足厥冷无脉者灸之不温若脉不还反微喘者死少阴负趺阳者为顺也（少
阴肾水趺阳脾土下利为肾邪干脾水不胜土则为微邪故为顺也）下利有微热而渴脉弱者今自愈伤寒发热下利厥逆躁不得卧
者死伤寒发热下利至甚厥不止者死（金匮要略曰六腑气绝于外者手足寒五脏气绝于内者利下不禁）伤寒六七日不利便发
热而利其人汗出不止者死有阴无阳故也（伤寒至七日为邪正相争之时正胜则生邪胜则死始不下利而暴忽发热下利汗出不
止者邪气胜正阳气脱也故死）伤寒下利日十余行脉反实者死（下利者里虚也脉当微弱反实者邪气胜也故死难经曰脉不应
病病不应脉是为死病）发热而厥七日下（利者）为难治（发热而厥邪传里也至七日传经尽则正气胜邪当汗出而解反下利
则邪气胜里气虚为难治）
戴 自利须辨阴阳三阳自利各于本经见之太阳与阳明合病下利头痛腰疼肌热目疼鼻干宜葛根汤太阳与少阳合病下
利身热胸胁痞满而呕或往来寒热目疼鼻干宜大柴胡汤大抵阳热之利与阴寒之利自不同阳利粪色必焦黄热臭出作声脐下
必热得凉药则止得热药愈增阴利必洞下清谷粪色或白或淡黄脐下多寒宜温中止泻之剂此阴利阳利指阴阳二气而言非曰
阴阳二经也缘阴中亦自有阳利不可因下利便以为阴也又有内不大满犹生寒热未可下而便下之内虚热入挟热自利脐下必
热大便赤黄色及下肠间津汁垢腻名曰利肠宜白头翁汤黄芩汤要知均为自利身不热手足自温者太阴身体四逆者少阴厥阴
其余身热下利皆属阳经然阴利有反发热或初病无热利后却热或初得病即身热继而自利此阴利非阳传阴经之利详见前条
发热证又有大便五六日以药利之利遂不止用极热剂方瘥阳有利阳有秘当更以他证别之外热内烦下利上渴或痞或痛或呕
常法多用黄芩汤半夏泻心汤亦可不若生姜泻心汤之当用温胆汤加入黄连其中枳壳去取在人
吴 凡自利者不因攻下而自泻利俗言漏底伤寒是也有协热有协寒俱宜详辨原病式曰泻白为寒青黄红黑皆为热也太
抵泻利完谷不化色不变有如惊溏或吐利腥臭小便澄澈清冷口无燥渴其脉或沉细或迟微无力或身虽热手足逆冷恶寒蜷卧
此皆为寒也凡热证则口中燥渴小便或黄赤或涩而不利或所下如垢腻之状其脉多数或浮或滑或弦或大或洪或有邪热不杀
谷其物不消化者当以脉证别之凡胃虚内热烦渴泻利脉弱者七味人参白术散若发热者参胡三白汤去黄芩加炒黄连若腹满
小便不利者五苓散合理中汤若呕者加藿香半夏生姜陈皮如湿多而泻不止者加苍术白术如腹胀者加浓朴腹疼不止加炒白
芍肉桂木香温之凡伤寒作利脉浮表未解者仲景以小青龙汤去麻黄加荛花二钱炒令赤色盖散表邪兼治水也若小便不利大
便水泻不止者宜五苓散水甚不解亦加荛花一钱以行水水行利自止也凡下利不可发汗当先治利止内实正气得复邪气得解
则汗出而愈也盖利下由内虚若加发汗则内外皆虚变证为难治也
附
活 寒毒入胃者脐下必寒腹胀满大便黄白或青黑或下利清谷宜四逆汤理中汤白通加附子汤四逆加薤白散挟热利者
脐下必热大便赤黄色及肠间津液垢腻宜黄芩汤白头翁汤三黄熟艾汤薤白汤赤石脂丸
三黄熟艾汤 治伤寒四日而大下热利时作白通汤诸药多不得止宜服此汤除热止利
黄芩 黄连 黄柏 熟艾（半鸡子大） 上 咀水煎温服
薤白汤 治伤寒下利如烂肉汁赤带下伏气腹痛诸热悉皆主之
豆豉（半合绵裹） 薤白（一握） 山栀（七枚）上 咀用水二升半先煮栀子十沸下薤白煎至二升下豉煎取一升二
合温服
赤石脂丸 治伤寒热利
赤石脂 干姜（炮各一两） 黄连 当归（各二两）为末炼蜜丸如桐子大每服三十丸米（饮下）日三服湿毒瓦斯盛者
利下腹痛大便如脓血或如烂肉汁宜桃花汤地榆散黄连阿胶汤
地榆散 治伤寒热毒不解日晚即壮热腹痛便利脓血
地榆 犀角屑 黄连（炒） 葛根（各一两） 栀子（半两） 黄芩（一两）上 咀每服五钱水一盏入薤白五寸同
煎温服
海 黄连阿胶汤 治伤寒热毒入胃下利脓血
黄芩（炒二两） 山栀（半两） 阿胶（炒） 黄柏（各一两）上 咀每服四钱水煎服
云 伤寒汗下后大小便利而腹中痛者宜燥肠丸
附子（炮一枚） 龙骨（半两） 干姜（一两） 吴茱萸 粟壳 诃黎皮（各半两）为细末酒糊丸桐子大每服三十
丸温水下利止勿服
伤寒汗下后里急后重下利者宜七宣丸
大黄（一两） 木香 槟榔 柴胡 诃子皮 甘草（各半两） 桃仁（三十枚去皮尖）上为细末炼蜜丸如桐子大每
服五十丸温水下
伤寒汗下后气逆利不止者寒也宜枳实芍药甘草汤
芍药 甘草 枳实（炒） 干姜（炮各半两）上 咀每服三钱水煎服
葱白（四两） 干姜（一两） 附子（一枚，生用，去皮，破成八片）以上三味药，用水三升，煎煮取汁一升，去渣，分两次温服。（《内经》说：肾恶燥急，应吃辛味食物来滋润它。葱白的辛味可以通调阳气，姜、附子的辛味可以驱散阴寒。）
白通加猪胆汁汤方
葱白（四茎） 干姜（一两） 附子（一枚，生用，去皮，破成八片） 人尿（五合） 猪胆汁（一合）以上五味药，用水三升，煎煮前三种药取汁一升，去渣，纳入胆汁和人尿，混合均匀，分两次温服。如果没有猪胆，也可以用其他替代品。（《内经》说：如果调理寒热逆乱，冷热交替必然导致病情加重，此时应将热药冷服。药物咽下之后，冷性先消解，热性随即发作，因此病气随之痊愈，呕吐哕逆皆除，情志不违且获得大益。这是将人尿、猪胆汁等咸苦寒之物加入白通汤的热剂中，旨在使其气味相从，从而消除格拒之寒邪。）
张景岳说：有人问，白通汤及白通加猪胆汁汤、真武汤与通脉四逆汤都是为少阴病下利而设的，除了都使用干姜、附子相同外，其余药物各不相同，为什么呢？这是因为病情不同所以用药各异。少阴病下利，寒气已经非常严重，不用姜、附则不能治疗。然而下利的机理虽然相同，但兼夹的症状不一，所以用药也不同，各自适宜于不同的情况。例如白通汤用姜、附以散寒止利，加葱白以通调阳气；如果下利伴有干呕、心烦，说明寒气太甚，在体内形成格拒，姜、附对于这种烦躁是不适宜的，服用后必致呕吐而不纳药，所以在白通汤中加入人尿、猪胆汁，待其变冷后服用。人尿、猪胆汁都是咸苦性寒之物，因此能纳受而不被阻拒，等到到达病所，冷体既消，热性便发。真武汤治疗少阴病二三日未愈，至四五日出现腹满、小便不利、四肢沉重疼痛、自下利，这是有水气所致，所以多有或然证。所谓水气，就是寒湿，由肾主管。肾病不能制水，水饮停蓄成为水气，腹痛是寒湿内盛，四肢沉重疼痛是寒湿外盛，小便不利、自下利是湿盛而水谷不能分别。经书说：脾恶湿，甘味先入脾。茯苓、白术的甘味可以健脾逐水。寒湿所胜，用平性的辛热药；湿淫所胜，佐以酸辛药。附子、芍药、生姜的酸辛可以温经散湿。太阳篇中的小青龙汤证也是因为有水气，所以多有或然证，这与真武汤的道理没有不同。通脉四逆汤治疗少阴病下利清谷、里寒外热、手足厥逆、脉微欲绝，其中里寒身热恶寒而面色赤为外热，这是阴寒盛于内，格阳于外，不相交通，故用通脉四逆汤以散阴通阳。其或然证根据法则加减治疗。以上四种证候都称为下利，但兼有的或然证不一，所以用药大同而小异。又有人说，白通汤用附子，上述四个证候中只有真武汤一证熟用附子，其余都生用，为什么呢？凡附子生用则温经散寒，非干姜辅助不可；炮熟则益阳除湿，用生姜相辅为宜。干姜辛热，所以辅助生附子发挥作用；生姜辛温，稍微资助熟附子的功效。原本辅佐使药的原理没有超出这个道理。然而白通等汤以下利为重症，真武汤证以寒湿为先，所以用药有轻重之分。大概寒淫风湿大体相似，如太阳编下的桂枝附子汤治疗寒湿相搏，附子也用炮熟的，仍用生姜来辅助。这生熟之用、轻重的区分，没有超过这个道理的。
少阴病咳嗽而下利，并见谵语，是被火气劫夺津液所致。小便必定困难，因为强行索取少阴汗出。（成无己注：咳嗽而下利，是里寒而亡失津液。反而用火法劫迫，强行索取少阴汗，导致津液内竭，加上火气烦扰，所以谵语，小便难。）
少阴病下利，大便带脓血的，可以针刺治疗。少阴病下利，脉象微涩，呕吐而汗出，必须频繁更衣却排便量少，应当在上部穴位施灸。少阴病脉紧，到了七八天，自下利，脉突然变微，手足反而温暖，脉紧反而消失，这是将要痊愈的表现。虽然心烦下利，也一定会自愈。少阴病脉微沉细，想睡觉，汗出而心烦，想吐，自下利，又烦躁不得睡眠的，死。少阴病下利停止，但头晕目眩，时时自觉头昏蒙的，死。（庞安时注：这应该是少阳病的昏冒汗出，但如果脉象匀小浮的还有一线生机。少阴病本无眩冒之证。）
厥阴病：伤寒开始发热六天，厥冷反而九天而下利。凡是厥冷下利的，应当不能进食，现在反而能进食，恐怕是“除中”证。给吃索饼（面条），如果不发热，就知道胃气尚在，会痊愈；恐怕是暴热来复又立即消失。三天后诊察脉搏，如果热度持续存在，预期在第二天半夜痊愈。之所以这样，是因为本来发热六天，厥冷反九天，后来又发热三天，加上前面的六天，一共九天，与厥冷天数相应，所以预期在第二天半夜痊愈。三天后诊察脉搏，如果脉数，热度不退，这是热气有余，一定会发生痈脓。（详见厥阴病篇）伤寒先厥冷后发热，下利必定自行停止，反而出汗、咽喉痛的，喉部会发生痹阻。发热无汗而下利的，必定自行停止，如果不停止，必定大便带脓血。大便带脓血的，喉部不会痹阻。下利，寸脉反而浮数，尺中自涩的，必定大便排脓血。（黄连阿胶汤、黄芩汤。成无己注：下利者脉应当沉而迟，反而浮数，说明里有热。涩为无血，尺中涩说明肠胃血散。热随利下，必定便脓血。“清”与“圊”通，指厕所。）
热利伴肛门重坠感的，用白头翁汤主治。（下利则津液少，热则伤气，气虚下利导致后重，给予白头翁汤以散气浓肠。）
下利想喝水的，是因为有热，用白头翁汤主治。（口渴自利，不是脏寒，不与四逆汤温脏。下利饮水为有热，与白头翁汤凉中。按少阴自利而渴，乃是下焦虚寒，应用四逆汤，恐怕不可以仅凭渴不渴来分热寒，正当以小便黄白来辨别。）
白头翁汤方
白头翁（二两） 黄柏 秦皮 黄连（各三两）以上四味药，用水七升，煎煮取汁二升，去渣，温服一升，不好再服一升。（《内经》说：肾欲坚，急食苦以坚之。下利则下焦虚，所以用纯苦之剂来坚固它。）
下利，脉数，有微热汗出，现在将要自愈。如果脉再次变紧，为病未解。（可用干姜黄连人参汤）
下利，脉数而口渴的，现在将要自愈。如果不愈，必定大便排脓血，是因为有热。（可用黄连汤）
下利，脉沉弦的，是肛门重坠感。脉大的，病未停止。脉微弱数的，病将要自行停止，虽然有发热也不会死。（成无己注：沉为在里，弦为拘急，里气不足，主下重。大则病进，为下利未止。脉微数弱者，邪气微而阳气复，为欲自止。虽有发热，只由阳胜，非大逆。脉沉弦属四逆汤之类，脉大属葛根黄芩黄连汤。）
伤寒六七天，经过大力攻下后，寸脉沉而迟，手足厥逆，下部脉摸不到，咽喉不利，唾脓血，泄利不止的，为难治，用麻黄升麻汤主治。（成无己注：伤寒六七天，邪传厥阴之时，大力攻下之后，下焦气虚，阳气内陷。寸脉迟而手足厥逆，下部脉不至。厥阴之脉贯膈上注肺，循喉咙。因亡津液，遂成肺痿，咽喉不利而唾脓血。《金匮要略》说：肺痿之病从何得之？被快药下利，重亡津液，故得之。若泄利不止，为里气大虚，所以说难治。给予麻黄升麻汤以调和肝肺之气。）
麻黄升麻汤方
麻黄（去节二两半） 升麻 当归（各一两二钱半） 知母 黄芩 葳蕤（各十八铢） 石膏（碎，绵裹） 白术 干姜 芍药 天门冬（去心） 桂枝 茯苓 甘草（炙，各六铢）
以上十四味药，用水一斗，先煮麻黄一两沸，去掉上面的沫，纳入诸药，煎煮取汁三升，去渣，分三次温服。间隔时间如同做一顿饭的时间（约三斗米顷），让药液服尽，出汗即愈。（成无己注：《玉函经》说：大热之气，用寒凉来取之；甚热之气，用发汗来发散。麻黄、升麻的甘味以发散浮热；正气虚者，用辛润之品，当归、桂枝、干姜的辛味以散寒；上热者，用苦泄之法，知母、黄芩的苦凉以清心去热；津液少者，用甘润之品，茯苓、白术的甘味缓脾生津；肺燥气热，用酸收之法，以甘缓之，芍药的酸味以敛逆气；葳蕤、门冬、石膏、甘草的甘味润肺除热。）
厥阴病，消渴，气上撞心，心中疼热，饥而不欲食，食则吐蛔，下之则利不止。（详见厥阴病篇）
伤寒四五日，腹中痛，如果有转气下趋少腹的感觉，这是想要自下利。（详见腹痛篇）
脉浮而迟，表热里热，下利清谷，用四逆汤。大汗出，热不去，内拘急，四肢疼，又下利、厥逆而恶寒的，用四逆汤。下利清谷，里寒外热，汗出而厥的，用通脉四逆汤。大汗，或者大下利而厥冷的，用四逆汤。下利清谷，不可攻表，汗出必胀满，用四逆汤。伤寒先厥冷后发热而利的，必定自行停止，见到厥冷又下利，用四逆汤。下利，脉沉而迟，其人面颊微红，身体有微热，下利清谷的，必定郁冒汗出而解。病患必定轻微厥冷，因为下虚的缘故，用四逆汤。下利后脉绝，手足厥冷，过一周左右脉还复，手足温暖的，生；脉不还复的，死。（或用白通汤、通脉四逆汤）。下利后更心烦，按之心下软的，是虚烦，用栀子豉汤。下利谵语，有燥屎的，宜用小承气汤。下利，手足厥冷，无脉的，施灸后若不温暖，如果脉不还复，反而微喘的，死。少阴脉弱于趺阳脉的为顺证。（少阴属肾水，趺阳属脾土。下利为肾邪干脾，水不胜土，则为微邪，故为顺证。）
下利有微热而渴，脉弱的，现在将要自愈。伤寒发热，下利厥逆，躁不得卧的，死。伤寒发热，下利至极，厥不止的，死。（《金匮要略》说：六腑气绝于外者，手足寒；五脏气绝于内者，利下不禁。）
伤寒六七天，本不该下利却突然发热而下利，其人汗出不止的，死，有阴无阳的缘故。（伤寒至七天为邪正相争之时，正胜则生，邪胜则死。始不下利而暴忽发热下利汗出不止者，邪气胜，正阳气脱，故死。）
伤寒下利，一天十多次，脉反而实的，死。（下利者里虚，脉当微弱，反实者邪气胜，故死。《难经》说：脉不应病，病不应脉，是为死病。）
发热而厥，七天，下利的，为难治。（发热而厥，邪传里。至七天传经尽，则正气胜邪，应当汗出而解。反下利，则邪气胜，里气虚，为难治。）
戴元礼说：自下利必须辨别阴阳。三阳经自下利，各自在本经症状中出现。太阳与阳明合病下利，头痛腰疼，肌热，目疼鼻干，宜用葛根汤。太阳与少阳合病下利，身热，胸胁痞满而呕，或往来寒热，目疼鼻干，宜用大柴胡汤。大抵阳热之利与阴寒之利自然不同。阳利粪便颜色必焦黄，气味热臭，排出有声，脐下必热，得凉药则止，得热药则加重。阴利必洞泻清谷，粪便颜色或白或淡黄，脐下多寒，宜用温中止泻之剂。这里说的阴利阳利是指阴阳二气而言，不是说阴阳二经。因为阴证中也有阳利，不可因下利就认为是阴证。又有内不大满，犹生寒热，不可攻下而便攻下，导致内虚热入，挟热自利，脐下必热，大便赤黄色，及下肠间津汁垢腻，名叫“利肠”，宜用白头翁汤、黄芩汤。要知道均为自下利，身体不热、手足自温的是太阴病，身体四逆的是少阴、厥阴病，其余身热下利皆属阳经。然而阴利有反发热，或初病无热，利后却发热，或初得病即身热，继而自下利，此阴利非阳传阴经之利，详见前条发热证。又有大便五六日用药利之，利遂不止，用极热剂才痊愈。阳有利，阳有秘，应当以其他证候来辨别。外热内烦下利，上渴，或痞或痛或呕，常法多用黄芩汤、半夏泻心汤，也不如生姜泻心汤恰当。温胆汤加入黄连，其中的枳壳去掉，取舍在于人。
吴谦说：凡是自下利，不因攻下而自泻利，俗言漏底伤寒。有协热，有协寒，俱宜详细辨别。《原病式》说：泻下白色为寒，青黄红黑皆为热。大抵泻利完谷不化，颜色不变，有如惊溏，或吐利腥臭，小便澄澈清冷，口无燥渴，其脉或沉细或迟微无力，或身虽热手足逆冷，恶寒蜷卧，这些都是寒证。凡热证则口中燥渴，小便或黄赤或涩而不利，或所下如垢腻之状，其脉多数或浮或滑或弦或大或洪，或有邪热不杀谷，其物不消化者，应当以脉证辨别。凡胃虚内热烦渴泻利脉弱的，用七味人参白术散。若发热者，用参胡三白汤去黄芩加炒黄连。若腹满小便不利者，用五苓散合理中汤。若呕吐者，加藿香、半夏、生姜、陈皮。如湿多而泻不止者，加苍术、白术。如腹胀者，加厚朴。腹疼不止加炒白芍、肉桂、木香温之。凡伤寒作利，脉浮表未解者，仲景用小青龙汤去麻黄加荛花二钱，炒令赤色，盖散表邪兼治水也。若小便不利，大便水泻不止者，宜五苓散。水甚不解亦加荛花一钱以行水，水行利自止也。凡下利不可发汗，当先治利，止内实正气得复，邪气得解，则汗出而愈也。盖利下由内虚，若加发汗则内外皆虚，变证为难治也。
附录
活人书说：寒毒入胃者，脐下必寒，腹胀满，大便黄白或青黑，或下利清谷，宜四逆汤、理中汤、白通加附子汤、四逆加薤白散。挟热利者，脐下必热，大便赤黄色及肠间津液垢腻，宜黄芩汤、白头翁汤、三黄熟艾汤、薤白汤、赤石脂丸。
三黄熟艾汤：治伤寒四日而大下，热利时作，白通汤诸药多不得止，宜服此汤除热止利。
黄芩 黄连 黄柏 熟艾（半鸡子大） 上药切碎，水煎，温服。
薤白汤：治伤寒下利如烂肉汁，赤带下，伏气腹痛，诸热悉皆主之。
豆豉（半合，绵裹） 薤白（一握） 山栀（七枚） 上药切碎，用水二升半，先煮栀子十沸，下薤白煎至二升，下豉煎取一升二合，温服。
赤石脂丸：治伤寒热利。
赤石脂 干姜（炮，各一两） 黄连 当归（各二两） 为末，炼蜜丸如桐子大。每服三十丸，米饮送下，日三服。湿毒瓦斯盛者，利下腹痛，大便如脓血或如烂肉汁，宜桃花汤、地榆散、黄连阿胶汤。
地榆散：治伤寒热毒不解，日晚即壮热，腹痛便利脓血。
地榆 犀角屑 黄连（炒） 葛根（各一两） 栀子（半两） 黄芩（一两） 上药切碎。每服五钱，水一盏，入薤白五寸同煎，温服。
海藏说：黄连阿胶汤：治伤寒热毒入胃，下利脓血。
黄芩（炒二两） 山栀（半两） 阿胶（炒） 黄柏（各一两） 上药切碎。每服四钱，水煎服。
云岐子说：伤寒汗下后大小便利而腹中痛者，宜燥肠丸。
附子（炮一枚） 龙骨（半两） 干姜（一两） 吴茱萸 粟壳 诃黎皮（各半两） 为细末，酒糊丸桐子大。每服三十丸，温水下。利止勿服。
伤寒汗下后里急后重下利者，宜七宣丸。
大黄（一两） 木香 槟榔 柴胡 诃子皮 甘草（各半两） 桃仁（三十枚，去皮尖） 上为细末，炼蜜丸如桐子大。每服五十丸，温水下。
伤寒汗下后气逆利不止者，寒也，宜枳实芍药甘草汤。
芍药 甘草 枳实（炒） 干姜（炮，各半两） 上药切碎。每服三钱，水煎服。
Scallion White (Cibuli Bulbus, 4 liang), Dried Ginger (Ganjiang, 1 liang), Aconite Root (Fuzi, 1 raw piece, peeled and broken into eight slices). The above three ingredients are boiled in three sheng of water to obtain one sheng of decoction. Strain the dregs and divide into two warm doses. (*Neijing* states: The Kidney dislikes dryness and urgency; eat pungent foods to moisten it. The pungency of Scallion White unblocks Yang Qi, while the pungency of Ginger and Aconite disperses Yin Cold.)
Baotong Decoction plus Pig Bile Formula
Scallion White (four stems), Dried Ginger (Ganjiang, 1 liang), Aconite Root (Fuzi, 1 raw piece, peeled and broken into eight slices), Human Urine (Ren Niao, 5 he), Pig Bile (Zhu Danzhi, 1 he). The above five ingredients: boil the first three in three sheng of water to obtain one sheng of decoction. Strain the dregs, add the bile and human urine, mix well, and divide into two warm doses. If pig bile is unavailable, alternatives may be used. (*Neijing* states: When regulating reversed cold-heat, if cold and heat alternate, the condition will worsen. In such cases, hot medicines should be taken cold. After swallowing, the cold nature dissipates first, then the hot nature activates, causing the pathogenic qi to resolve, vomiting and hiccups to cease, and emotions to remain harmonious, bringing great benefit. This involves adding salty-bitter-cold substances like human urine and pig bile to the hot Baotong Decoction, aiming for their qi to follow each other, thereby eliminating the cold that causes rejection.)
Zhang Jingyue said: Some ask why Baotong Decoction, Baotong Decoction plus Pig Bile, Zhenwu Decoction, and Tongmai Sini Decoction are all prescribed for Shaoyin disease with diarrhea, yet besides using Ginger and Aconite, the remaining herbs differ significantly. The answer lies in the principle that different diseases require different medications. In Shaoyin diarrhea, the cold pathogen is severe, requiring Ginger and Aconite for treatment. Although the mechanism of diarrhea is similar, accompanying symptoms vary, necessitating different prescriptions suited to specific conditions. For instance, Baotong Decoction uses Ginger and Aconite to disperse cold and stop diarrhea, adding Scallion White to regulate Yang Qi. If diarrhea is accompanied by dry retching and irritability, the cold is too severe, causing internal rejection; Ginger and Aconite are unsuitable here as they may induce vomiting and prevent absorption. Therefore, human urine and pig bile are added to Baotong Decoction and taken when cool. These are salty-bitter-cold substances that facilitate acceptance without obstruction. Once reaching the site, the cold nature dissipates, and the hot nature activates. Zhenwu Decoction treats Shaoyin disease persisting for two to three days, progressing to four or five days with abdominal fullness, difficult urination, heavy/painful limbs, and spontaneous diarrhea, indicating water retention. Water retention refers to cold-dampness governed by the Kidney. Kidney dysfunction fails to control water, leading to fluid accumulation. Abdominal pain indicates severe internal cold-dampness; heavy/painful limbs indicate severe external cold-dampness; difficult urination and diarrhea indicate dampness preventing the separation of water and grain. The Classics state: The Spleen dislikes dampness; sweet flavors enter the Splein first. Poria (Fuling) and Atractylodes Macrocephala (Baizhu) have sweet flavors to tonify the Spleen and drain water. For cold-damp dominance, use neutral-pungent-hot herbs; for damp excess, assist with sour-pungent herbs. The sour-pungent nature of Aconite, Peony, and Fresh Ginger warms meridians and dispels dampness. In the Taiyang chapter, Xiao Qinglong Tang syndrome also involves water retention and multiple variable symptoms, sharing the same logic as Zhenwu Decoction. Tongmai Sini Decoction treats Shaoyin diarrhea with undigested food, interior cold with exterior heat, cold extremities, and faint pulse. Interior cold manifests as fever, aversion to cold, and red facial color due to exterior heat. This represents Yin cold prevailing internally, repelling Yang externally, disrupting communication. Tongmai Sini Decoction is used to disperse Yin and unblock Yang. Variable symptoms are treated with modifications based on principles. All four syndromes involve diarrhea with various accompanying symptoms, resulting in major similarities but minor differences in prescription. Another query: Why is processed Aconite used only in Zhenwu Decoction among these four, while raw Aconite is used in others? Raw Aconite warms meridians and dispels cold, requiring Ginger's assistance; processed Aconite tonifies Yang and removes dampness, suitably assisted by Fresh Ginger. Dried Ginger is pungent-hot, assisting raw Aconite; Fresh Ginger is pungent-warm, slightly supporting processed Aconite. This reflects the original rationale for auxiliary herbs. However, Baotong-type formulas prioritize stopping diarrhea, whereas Zhenwu Decoction prioritizes cold-dampness, explaining dosage variations. Generally, cold-dampness shares similarities; e.g., Guizhi Fuzi Tang in the Taiyang section uses processed Aconite with Fresh Ginger for cold-damp binding, illustrating this principle of raw vs. processed usage and dosage differentiation.
Shaoyin disease with cough and diarrhea, accompanied by delirium, results from fire therapy劫夺 (seizing/robbery) of fluids. Urination will certainly be difficult due to forcibly inducing sweat from the Shaoyin. (Cheng Wuji notes: Cough and diarrhea indicate interior cold and fluid depletion. Using fire therapy to forcibly induce Shaoyin sweat depletes internal fluids further. Combined with fire heat irritation, delirium and difficult urination occur.)
Shaoyin disease with diarrhea and pus/blood in stool can be treated with acupuncture. Shaoyin disease with diarrhea, faint and choppy pulse, vomiting, sweating, frequent defecation attempts with little output, should be treated with moxibustion on upper acupoints. Shaoyin disease with tight pulse, progressing to day seven with spontaneous diarrhea, sudden mild pulse, warm hands/feet, and disappearance of tight pulse indicates recovery. Despite irritability and diarrhea, self-healing is expected. Shaoyin disease with faint, deep, fine pulse, desire to sleep, sweating, irritability, nausea, spontaneous diarrhea, restlessness, and insomnia indicates death. Shaoyin disease where diarrhea stops but dizziness occurs with occasional vertigo indicates death. (Pang Anshi notes: This resembles Shaoyang vertigo and sweating. If the pulse is uniform, small, and floating, survival is possible. Shaoyin disease typically lacks vertigo.) Shaoyin disease with aversion to cold, curled body posture, diarrhea, and cold extremities is untreatable.
Jueyin disease: Shanyin initially febrile for six days, followed by nine days of cold extremities and diarrhea. Typically, cold/diarrhea patients cannot eat. Current ability to eat suggests "Chu Zhong" (stomach qi exhaustion). Testing with noodles: if no fever follows, stomach qi remains, and recovery is expected. Fear of sudden heat returning and disappearing. Three days later, if pulse shows sustained heat, recovery is expected at midnight the next day. Reason: Initial six days fever + nine days cold + subsequent three days fever = nine days total, matching the cold period, predicting recovery at midnight. If pulse is rapid and heat persists after three days, excess heat will cause abscesses/pus. (See Jueyin Disease section.) Shanyin starting with cold extremities then fever usually stops diarrhea spontaneously. If sweating and sore throat occur, throat bi (obstruction) develops. Fever without sweat and diarrhea usually stops spontaneously; if not, pus/blood in stool appears. Pus/blood in stool prevents throat bi. Diarrhea with floating-rapid cun pulse and choppy chi pulse indicates pus/blood in stool. (Huanglian Ejiao Tang, Huangqin Tang. Cheng Wuji notes: Diarrhea pulse should be deep-slow; floating-rapid indicates interior heat. Choppy indicates blood deficiency; choppy chi pulse indicates intestinal blood scattering. Heat follows diarrhea, causing pus/blood stool. "Qing" connects to toilet.)
Heat diarrhea with tenesmus is primarily treated with Baitouweng Tang. (Diarrhea reduces fluids; heat damages qi. Qi deficiency leads to tenesmus. Baitouweng Tang disperses qi and thickens intestines.)
Diarrhea with thirst indicates heat, primarily treated with Baitouweng Tang. (Thirst with diarrhea is not organ cold; does not match Sini Tang warming organs. Thirst with diarrhea indicates heat, matched with Baitouweng Tang cooling middle. Regarding Shaoyin spontaneous diarrhea with thirst being lower jiao deficiency-cold treated with Sini Tang, relying solely on thirst/non-thirst to distinguish heat/cold is insufficient; yellow/white urine should differentiate.)
Baitouweng Tang Formula
Baitouweng Root (Polygala Tenuifolia Radix, 2 liang), Phellodendron Bark (Huangbai, 3 liang), Ash Bark (Qinpi, 3 liang), Coptis Rhizome (Huanglian, 3 liang). Boil four ingredients in seven sheng of water to obtain two sheng. Strain, take one sheng warm. If ineffective, take another sheng. (*Neijing*: Kidney desires firmness; urgent situations require bitter taste to firm it. Diarrhea causes lower jiao deficiency, so pure bitter agents are used to firm it.)
Diarrhea with rapid pulse, slight fever, and sweating indicates impending recovery. If pulse becomes tight again, unresolved. (Use Ganjiang Huanglian Renshen Tang.)
Diarrhea with rapid pulse and thirst indicates impending recovery. If not resolved, pus/blood in stool will occur due to heat. (Use Huanglian Tang.)
Diarrhea with deep-chordic pulse indicates tenesmus. Large pulse means progression/unresolved. Weak-rapid pulse means approaching resolution; even with fever, death is unlikely. (Cheng Wuji notes: Deep indicates interior; chordic indicates tension/lack of interior qi causing heaviness. Large pulse indicates disease progression. Weak-rapid pulse indicates declining pathogen and recovering yang. Fever due to yang victory is not adverse. Deep-chordic pulse suits Sini Tang category; large pulse suits Gegen Huangqin Huanglian Tang.)
Shanyin after six-seven days, following drastic purgation, presents with deep-slow cun pulse, cold extremities, absent lower pulses, blocked throat, spitting pus/blood, and uncontrollable diarrhea. This is difficult to treat; use Mahuang Shengma Tang. (Cheng Wuji notes: At six-seven days, pathogen enters Jueyin. Drastic purgation weakens lower jiao qi, sinking yang. Deep-slow cun pulse and cold extremities/absent lower pulses reflect Jueyin meridian passing through diaphragm to lung/throat. Fluid loss causes Lung萎 (withering), throat blockage, and pus/blood sputum. *Jingui Yaolue*: Lung withering arises from harsh purgatives causing severe fluid loss. Uncontrollable diarrhea indicates severe interior deficiency, hence difficult. Mahuang Shengma Tang regulates Liver-Lung qi.)
Mahuang Shengma Tang Formula
Ephedra Stem (Mahuang, removed nodes, 2.5 liang), Cimicifuga Rhizome (Shengma, 1.25 liang), Angelica Sinensis Root (Danggui, 1.25 liang), Anemarrhena Rhizome (Zhimu, 18 zhu), Scutellaria Root (Huangqin, 18 zhu), Polygonatum Rhizome (Weirui, 18 zhu), Gypsum Fibrosum (Shigao, crushed, wrapped in silk), Atractylodes Macrocephala Rhizome (Baizhu, 6 zhu), Dried Ginger (Ganjiang, 6 zhu), White Peony Root (Shaoyao, 6 zhu), Asparagus Tuber (Tianmendong, removed heart, 6 zhu), Cinnamon Twig (Guizhi, 6 zhu), Poria (Fuling, 6 zhu), Licorice Root (Gancao, roasted, 6 zhu).
Boil fourteen ingredients in one dou of water. First boil Mahuang until boiling, remove foam. Add remaining herbs, boil to obtain three sheng. Strain, divide into three warm doses. Take within the time it takes to cook three dou of rice. Sweating indicates cure. (Cheng Wuji notes: *Yuhan Jing*: Great heat requires cold to subdue; intense heat requires sweating to release. Mahuang/Shengma sweetness releases floating heat. Deficient righteous qi requires pungent-moistening agents; Danggui/Guizhi/Ganjiang pungency disperses cold. Upper heat requires bitter-draining; Zhimu/Huangqin bitterness-coolness clears heart heat. Fluid deficiency requires sweet-moistening; Fuling/Baizhu sweetness soothes Spleen and generates fluids. Lung dryness-heat requires astringent-sweet method; Shaoyao sourness restrains rebellious qi. Weirui/Tianmendong/Shigao/Gancao sweetness moistens Lung and clears heat.)
Jueyin disease: Excessive thirst, qi rushing up to the heart, burning pain in the heart, hunger without desire to eat, vomiting roundworms upon eating, and worsening diarrhea if purged. (See Jueyin Disease section.)
Shanyin on day four-five, abdominal pain with gas moving toward the lower abdomen indicates impending diarrhea. (See Abdominal Pain section.)
Floating-slow pulse, exterior heat, interior heat, diarrhea with undigested food: Use Sini Tang. Profuse sweating, persistent heat, internal cramping, limb pain, plus diarrhea, cold extremities, aversion to cold: Use Sini Tang. Diarrhea with undigested food, interior cold with exterior heat, sweating with cold extremities: Use Tongmai Sini Tang. Profuse sweating or massive diarrhea with cold extremities: Use Sini Tang. Diarrhea with undigested food, do not attack exterior; sweating causes abdominal fullness: Use Sini Tang. Shanyin starting with cold then fever stops diarrhea; return of cold brings back diarrhea: Use Sini Tang. Diarrhea with deep-slow pulse, slightly red face, slight body heat, diarrhea with undigested food: Expect depression/sweating resolution. Patient likely has mild cold extremities due to lower deficiency: Use Sini Tang. Post-diarrhea pulseless, cold extremities: If pulse returns and extremities warm within a week, survival; if not, death. (Use Baotong Tang or Tongmai Sini Tang.) Post-diarrhea increased irritability, soft epigastrium on palpation indicates empty irritability: Use Zhizi Chihui Tang. Diarrhea with delirium and dry feces: Use Xiaochengqi Tang. Diarrhea with cold extremities and no pulse: Moxibustion if not warming. If pulse doesn't return and slight panting occurs, death. Shaoyin weaker than Dubo pulse is favorable. (Shaoyin Kidney Water vs. Dubo Spleen Earth. Diarrhea implies Kidney evil attacking Spleen; Water failing to overcome Earth is mild evil, thus favorable.)
Diarrhea with slight fever, thirst, and weak pulse indicates recovery. Shanyin fever, severe diarrhea, cold extremities, restlessness, inability to lie down: Death. Shanyin fever, extreme diarrhea, unrelenting cold extremities: Death. (*Jingui Yaolue*: Six Fu organs failing externally cause cold hands/feet; Five Zang organs failing internally cause uncontrollable diarrhea.)
Shanyin day six-seven, sudden fever with diarrhea and unstoppable sweating: Death, presence of Yin without Yang. (Day seven marks struggle between pathogen and righteous qi. Victory of righteous qi brings life; pathogen victory brings death. Sudden fever/diarrhea/sweating indicates pathogen victory and Yang collapse.)
Shanyin diarrhea occurring ten-plus times daily with strong pulse: Death. (Diarrhea indicates interior deficiency; pulse should be weak/faint. Strong pulse indicates pathogen victory. *Nanjing*: Pulse mismatching disease indicates death.)
Fever with cold extremities for seven days, followed by diarrhea: Difficult to treat. (Fever/cold indicates pathogen entering interior. By day seven, transmission completes; righteous qi should win, causing sweating/resolution. Diarrhea indicates pathogen victory and interior weakness.)
Dai Yuanli said: Spontaneous diarrhea must distinguish Yin/Yang. Three Yang spontaneous diarrhea presents in respective meridians. Taiyang-Yangming combined disease with diarrhea, headache, waist pain, muscle heat, eye pain, nasal dryness: Ge Gen Tang. Taiyang-Shaoyang combined disease with diarrhea, body heat, chest/hypochondriac fullness, vomiting, alternating chills/fever, eye pain, nasal dryness: Da Chai Hu Tang. Generally, Yang heat diarrhea differs from Yin cold diarrhea. Yang diarrhea features dark yellow foul-smelling stool, audible expulsion, warm umbilicus, relief with cool meds, worsening with hot meds. Yin diarrhea features clear undigested food, white/pale yellow stool, cold umbilicus, treated with warming/astringent agents. Here, Yin/Yang refers to Qi, not meridians. Yin conditions can have Yang diarrhea; don't assume all diarrhea is Yin. Internal fullness with chills/fever shouldn't be purged; improper purging causes interior deficiency, heat entry, and heat-carrying diarrhea with warm umbilicus, dark yellow stool, and greasy intestinal fluid ("Li Chang"), treated with Baitouweng Tang or Huangqin Tang. Note: Non-febrile, warm extremity diarrhea is Taiyin; cold extremity diarrhea is Shaoyin/Jueyin. Other febrile diarrhea belongs to Yang meridians. Yin diarrhea may feature rebound fever, post-diarrhea fever, or initial fever followed by diarrhea, distinct from Yang transmitting to Yin. See Febrile Disease section. Also, prolonged laxative use causing unremitting diarrhea requires extreme hot agents. Yang has diarrhea/constipation; differentiate via other signs. Exterior heat/internal irritability/diarrhea, thirst, distension/pain/vomiting: Often use Huangqin Tang or Banxia Xiexin Tang, but Shengjiang Xiexin Tang is often better. Wendan Tang plus Huanglian, removing Zhi Shi, choice depends on practitioner.
Wu Qian said: Spontaneous diarrhea not caused by purgatives is colloquially "Lou Di Shang Han." Differentiate heat-carrying vs. cold-carrying. *Yuan Bing Shi* states: White stool indicates cold; green/yellow/red/black indicates heat. Complete undigested food, unchanged color, akin to fright loose stools, or foul vomiting/diarrhea, clear cold urine, no oral dryness, deep/faint/weak pulse, or fever with cold extremities/aversion to cold/curled posture: Cold syndrome. Heat syndrome features oral dryness/thirst, yellow/scanty urine, greasy stool, rapid/floating/sliding/chordic/large/hyperactive pulse, or heat failing to digest food. Differentiate by pulse/symptoms. Stomach deficiency with internal heat/irritability/thirst/diarrhea/weak pulse: Qiwei Renshen Baizhu San. With fever: Shenhu Sanbai Tang minus Huangqin plus fried Huanglian. Abdominal fullness/difficult urination: Wuling San combined with Lizhong Tang. Vomiting: Add Huoxiang, Banxia, Shengjiang, Chenpi. Heavy dampness/unremitting diarrhea: Add Cangzhu, Baizhu. Abdominal distension: Add Houpo. Abdominal pain: Add fried Shaoyao, Rougui, Muxiang to warm. Shanyin diarrhea with floating pulse (exterior unresolved): Zhang Zhongjing uses Xiao Qinglong Tang minus Mahuang plus Ruanghua (fried red) to scatter exterior and manage water. Difficult urination/watery diarrhea: Wuling San. Severe water retention adds Ruanghua to move water, stopping diarrhea. Diarrhea contraindicates sweating; treat diarrhea first. Once interior solidifies, righteous qi recovers, pathogen resolves, and sweating occurs naturally. Diarrhea stems from interior deficiency; sweating causes dual deficiency, making complications difficult.
Appendix
Huoren Shu says: Cold toxin entering stomach causes cold umbilicus, abdominal fullness, yellow/white/green/black stool, or clear undigested food diarrhea: Sini Tang, Lizhong Tang, Baotong plus Fuzi Tang, Sini plus Xiebai San. Heat-carrying diarrhea causes warm umbilicus, dark yellow stool, greasy intestinal fluid: Huangqin Tang, Baitouweng Tang, Sanhuang Shuai Ai Tang, Xiebai Tang, Chishizhi Wan.
Sanhuang Shuai Ai Tang: Treats Shanyin day four post-drastic purgation, intermittent heat diarrhea unresponsive to Baotong Tang. Clears heat, stops diarrhea.
Huangqin, Huanglian, Huangbai, Shuai Ai (half egg size). Chop, decoct in water, take warm.
Xiebai Tang: Treats Shanyin diarrhea like rotten meat juice, bloody discharge, latent qi abdominal pain, all heat types.
Dou Chi (half he, wrapped), Xiebai (one handful), Zhizi (seven pieces). Chop, boil in 2.5 sheng water. Boil Zhizi ten times, add Xiebai, boil to 2 sheng, add Dou Chi, boil to 1.2 sheng. Take warm.
Chishizhi Wan: Treats Shanyin heat diarrhea.
Chishizhi, Fried Ganjiang (1 liang each), Huanglian, Danggui (2 liang each). Powder, honey pills like wattle seeds. 30 pills per dose, rice water, three times daily. For severe damp-toxin, abdominal pain, pus/blood or rotten meat-like stool: Taohua Tang, Diyü San, Huanglian Ejiao Tang.
Diyü San: Treats Shanyin unresolved heat toxin, evening high fever, abdominal pain, pus/blood stool.
Diyü, Xijiao Xie, Fried Huanglian, Gegen (1 liang each), Zhizi (0.5 liang), Huangqin (1 liang). Chop. 5 qian per dose, one cup water, add 5 cun Xiebai, decoct, take warm.
Haizang says: Huanglian Ejiao Tang: Treats Shanyin heat toxin entering stomach, pus/blood diarrhea.
Fried Huangqin (2 liang), Zhizi (0.5 liang), Fried Ejiao, Huangbai (1 liang each). Chop. 4 qian per dose, decoct in water.
Yun Qizi says: Post-shanyin sweating/purgation, free urination/defecation with abdominal pain: Zaochang Wan.
Fried Fuzi (1 piece), Longgu (0.5 liang), Ganjiang (1 liang), Wuzhuyu, Susuke, Helipi (0.5 liang each). Fine powder, wine paste pills like wattle seeds. 30 pills per dose, warm water. Stop when diarrhea ceases.
Post-shanyin sweating/purgation, tenesmus/diarrhea: Qixuan Wan.
Dahuang (1 liang), Muxiang, Binglang, Chaihu, Hezipi, Gancao (0.5 liang each), Tao Ren (30 pieces, peeled/cored). Fine powder, honey pills like wattle seeds. 50 pills per dose, warm water.
Post-shanyin sweating/purgation, rebellious qi/unremitting diarrhea (cold): Zhishi Shaoyao Gancao Tang.
Shaoyao, Gancao, Fried Zhishi, Fried Ganjiang (0.5 liang each). Chop. 3 qian per dose, decoct in water.